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Original Articles
- Infection
- Risk factors associated with development of coinfection in critically Ill patients with COVID-19
- Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram
- Acute Crit Care. 2022;37(3):312-321. Published online August 29, 2022
- DOI: https://doi.org/10.4266/acc.2022.00136
- 1,406 View
- 164 Download
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Abstract
PDF - Background
At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.
Methods
Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.
Results
Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.
Conclusions
Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.
- Cardiology
- Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge
- Abarna Ramanathan, John Paul Pearl, Manshi Li, Xiaofeng Wang, Divyajot Sadana, Abhijit Duggal
- Acute Crit Care. 2021;36(4):317-321. Published online November 29, 2021
- DOI: https://doi.org/10.4266/acc.2021.00577
- 2,768 View
- 100 Download
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Abstract
PDF
- Background
Atrial fibrillation of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years post hospital discharge for critically ill patients.
Methods
This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1st, 2012, to October 31st, 2015, were screened. Those designated with atrial fibrillation (AF) for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model.
Results
Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence.
Conclusions
Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.
- Pulmonary
- Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay
- Francois Abi Fadel, Mohammed Al-Jaghbeer, Sany Kumar, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton
- Acute Crit Care. 2020;35(4):242-248. Published online October 12, 2020
- DOI: https://doi.org/10.4266/acc.2020.00619
- 4,583 View
- 266 Download
- 9 Citations
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Abstract
PDF
- Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time. -
Citations
Citations to this article as recorded by
- Racial inequality in COVID-treatment and in-hospital length of stay in the US over time
Benjamin M. Althouse, Charlotte Baker, Peter D. Smits, Samuel Gratzl, Ryan H. Lee, Brianna M. Goodwin Cartwright, Michael Simonov, Michael D. Wang, Nicholas L. Stucky
Frontiers in Public Health.2023;[Epub] CrossRef - Effects of race on the outcome of COVID-19 in hospitalized patients
Getahun Abate, Aniruddh Kapoor, Edward Charbek, Bryan Beck, Qian Wang, Grace C. Wang, Mackenzie Steck, Jason Zoglman, Robin R. Chambeg, Sharon Frey, Daniel F. Hoft, Timothy L. Wiemken
Journal of the National Medical Association.2022; 114(1): 56. CrossRef - Hospital length of stay for COVID-19 patients: A systematic review and meta-analysis
Yousef Alimohamadi, Elahe Mansouri Yekta, Mojtaba Sepandi, Maedeh Sharafoddin, Maedeh Arshadi, Elahe Hesari
Multidisciplinary Respiratory Medicine.2022;[Epub] CrossRef - Learning from the First Wave of the Pandemic in England, Wales, and Northern Ireland
David Pilcher, Matthew Durie
American Journal of Respiratory and Critical Care Medicine.2021; 203(5): 532. CrossRef - Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study
Muhammed Elhadi, Ahmed Alsoufi, Abdurraouf Abusalama, Akram Alkaseek, Saedah Abdeewi, Mohammed Yahya, Alsnosy Mohammed, Mohammed Abdelkabir, Mohammed Huwaysh, Emad Amkhatirah, Kamel Alshorbaji, Samer Khel, Marwa Gamra, Abdulmueti Alhadi, Taha Abubaker, Mo
PLOS ONE.2021; 16(4): e0251085. CrossRef - A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients
Abhishek Bhardwaj, Mahmoud Alwakeel, Talha Saleem, Saira Afzal, Sura Alqaisi, Aisha R. Saand, Hanan Al. Najjar, Lori Griffiths, Xiaozhen Han, Xiaofeng Wang, Silvia Perez-Protto, Benjamin S. Abella, David F. Gaieski, Abhijit Duggal, Francois Abi Fadel
Critical Care Explorations.2021; 3(5): e0425. CrossRef - Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19
Michael G Usher, Roshan Tourani, Gyorgy Simon, Christopher Tignanelli, Bryan Jarabek, Craig E Strauss, Stephen C Waring, Niall A M Klyn, Burke T Kealey, Rabindra Tambyraja, Deepti Pandita, Karyn D Baum
JAMIA Open.2021;[Epub] CrossRef - Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study
Abbas Al Mutair, Alyaa Elhazmi, Saad Alhumaid, Gasmelseed Ahmad, Ali Rabaan, Mohammed Alghadeer, Hiba Chagla, Raghavendra Tirupathi, Amit Sharma, Kuldeep Dhama, Khulud Alsalman, Zainab Alalawi, Ziyad Aljofan, Alya Al Mutairi, Mohammed Alomari, Mansour Awa
Medicina.2021; 57(9): 878. CrossRef - Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef
- Racial inequality in COVID-treatment and in-hospital length of stay in the US over time
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